Clinical and brain MRI appearances in neuromyelitis optica

Abstract

Objective To explore clinical features, brain magnetic resonance imaging (MRI) findings in neuromyelitis optica (NMO). Methods Twenty patients with NMO proved by clinical history or laboratory examinations were reviewed. Results Thirteen cases initially presented with acute myelitis, 7 cases with optic neuritis. Among all patients, 18 cases had a relapsing form of the disease. The main clinical manifestations included acute vision loss, concentric narrowing visual field or double vision (7 cases), muscle weakness, reduced sensation below the level of lesions, or autonomic dysfunction (13 cases). Ophthalmoscopy showed acute optic neuritis, papilledema (3 cases), retrobulbar optic neuritis (5 cases), or optic atrophy (4 cases). Immunoglobulin IgG⁃24 synthetic rate rose in 8 patients (8/18), serum NMO⁃IgG was positive in 6 cases (6/12), and oligoclonal bands (OCB) presented positive in 5 patients (5/18). Seven cases with optic neuritis showed extended P100 latency and (or) poor waveforms differentiation. Brain MRI was positive in 8 patients, and lesions typically localized in hypothalamus, pons, midbrain or periventricle areas. Conclusion Laboratory tests may contribute to the diagnosis and differential diagnosis of NMO. Hypothalamus, brainstem, pons or periventricle lesions, corresponded to high sites of aquaporin 4 (AQP4) in the brain, are typical features of NMO.

DOI：10.3969/j.issn.1672-6731.2011.03.014